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Experience with COVID-19 Vaccine While Pregnant

Authors: Negin Nia and Arrthy Thayaparan (Blog Coordinators) | Interviewing: Dr. Cindy Barha, PhD, Department of Physical Therapy; Dr. Chelsea Elwood, PhD, Department of Obstetrics and Gynecology

Published: October 9th, 2021

To go along with our latest blog looking at research and effects of the COVID-19 vaccine on pregnant women, the Women’s Health Blog spoke to Dr. Cindy Barha to hear her personal experience with receiving the vaccine during pregnancy.

While the information mentioned in this Q&A is the personal anecdote of Dr. Barha, everything mentioned has been verified and additional reading has been listed along with this blog.

When did you decide to get your vaccine?

I got pregnant in September of last year, a few months after COVID had hit, and the first wave was just ending. I had already decided that I was going to get it as soon as I was eligible to get the vaccine.

Why did you get vaccinated while pregnant? What was your thought process going into that?

I kept a close eye on data coming out of the United States and the UK. They were the only countries at the time that I could find that were actually keeping track of COVID infections in pregnant women. Everything I’d seen was pointing towards COVID symptoms being much more serious in pregnant women, compared to non-pregnant women of the same age.

So if you were pregnant and got COVID, you’d be at higher risk for being hospitalized and being put on a ventilator, compared to a woman that was not pregnant and the same age as you. So that just kept coming up every time I looked to see if any new data had been published.

As soon as I became eligible, and I had the opportunity in my second trimester, I jumped on it. I had no reservations about getting the vaccine. Nothing had come out in any of the studies I had seen to suggest that the vaccine was unsafe during pregnancy. I was always going to get the vaccine and I was actually really happy to receive it during my second trimester, because I was really hopeful that Baby would receive some protection. And this is exactly what is being seen in more recent studies, COVID antibodies are found in umbilical cord blood!

Other than your research, who did you go to for advice on informing your decision?

I had two excellent OBs (obstetricians) at BC Women’s hospital, Dr. Chelsea Elwood is one of them and she is an infectious disease expert. I had a couple of conversations with her, I was curious what experts thought [about getting the vaccine, while pregnant].

Around the same time, I had a family member and a friend who were also pregnant, and were both skeptical about getting the vaccine. So, I shared my experiences and the knowledge that I’ve been able to gather from the data with them. But I also asked Dr. Elwood if she had anything to share that I could pass on to them and she pretty much echoed everything I’d seen in studies looking at vaccine safety and efficacy.

Did you have any side effects after the vaccine?

I had very few side effects. In fact, I think I only had a sore arm for maybe 12 hours, and I think that was because I slept on that side. But I didn’t get a fever, or any aches or pains. It was basically like getting the flu shot at that point for me, and I don’t normally get any side effects from that either.

I mentioned this to Dr. Elwood and she told me about some data suggesting that women that are pregnant are suffering from less side effects from the COVID vaccine. My personal experience echoed what she was seeing in the data, that side effects seemed to be blunted in women that were getting their shots during pregnancy. I had the same experience from my second shot when I was breastfeeding. I had almost no side effects whatsoever.

How did you feel about any effects to your baby?

When I got my first shot during my second trimester, researchers had just started to see that the antibodies that were being produced from mRNA vaccines were crossing the placenta.

So Baby got some protection from my first shot. I got my second shot when i was about 3 months postpartum so Baby got antibodies from my second shot, as well through breastmilk.

In a way this was a good sort of vaccine schedule for me, because the baby got antibodies through the placenta and through breastmilk.

On a more cheerful note, how’s your baby now?

He’s great. He’s protected from COVID as far as I know. He’s four months old now and just living his life.

Is there anything you would like to share to people who are or looking to get pregnant and trying to decide whether they should get the vaccine?

I think what I would say is, don’t think only about yourself, but also think about your baby. The vaccine has been given to over 6 billion people, and a portion of those people were pregnant. There’s been no negative outcomes in terms of pregnancy or fertility in any of these cases.

So think about yourself, think about your baby. The vaccine is our best chance of getting through this pandemic. Without it, pregnant people are at a higher risk for being hospitalized, and that will potentially be harmful for your baby.

The Women’s Health blog also reached out to Dr. Chelsea Elwood, a clinical assistant professor at the University of British Columbia in the department of Obstetrics and Gynecology, to hear her recommendations.

What is the recommendation right now?

So we recommend, in line with the Society of Obstetricians and Gynecologists of Canada, and a large number of other international bodies, that persons who are pregnant, persons who are breastfeeding, and anyone planning a pregnancy get the COVID-19 vaccine.

Is there a certain time period when women should receive the vaccine?

As soon as it’s available. So we recommend that at any time in pregnancy, first trimester, second trimester, third trimester, they should get the vaccine, including postpartum.

When it comes to the different vaccines, is one better than the others? Is mixing vaccines an issue?

We recommend any of the COVID-19 vaccines in pregnancy. There is currently more published data, generally on Pfizer and Moderna, although we are expecting much more data from the United Kingdom on AstraZeneca. There’s no safety signals related to pregnancy with any of those vaccines. So we actually recommend any of them.

The data around vaccine mixing is continuing to be studied and emerging. To be honest, at this point in time, we recommend any of them as long as patients are fully vaccinated and can’t make a preferential recommendation of vaccine mixing versus not in pregnancy.

With the talk about boosters, do you think pregnant women should be getting a booster shot?

At this point in time, there’s no data to suggest that pregnant women respond any differently than their non-pregnant counterparts. So a woman who is pregnant and has, for example, an autoimmune disorder and would normally qualify for a booster, then they should get their booster. Pregnancy, in and of itself, is not a reason at this point in time to get a booster.

What do you have to say to folks worried about their babies and the vaccine?

Maternal vaccination for infant protection is a very well established modality to get babies protected from infectious diseases. We have traditionally seen that in the influenza vaccine, where moms are protected, babies are provided antibodies through placental transfer, as well as through breast milk afterwards.

We actually use maternal immunization for infant protection as a very good strategy to protect babies from whooping cough in the first couple of months after they’re born. And we recommend routinely the whooping cough vaccine in pregnancy for that reason. The COVID-19 vaccine is recommended primarily for maternal benefit. Meaning the outcomes that are being prevented by our mums getting COVID-19 vaccine, are ending up in the ICU hospitalized or having preterm birth by being vaccinated.

Being vaccinated in pregnancy, and the degree of which that is going to protect the baby from COVID-19 has yet to be seen, because we simply don’t have enough data at that point in time. But we would expect it to be protective in the same way that any other vaccine in pregnancy does, in that it would confer some protection for babies after they are delivered and through breast milk.

What would you like to say to the folks deciding whether they should get vaccinated?

I’d encourage them to reach out to their maternity care provider and have that conversation. The Society of Obstetricians and Gynecologists of Canada and most of the provinces have great resources available to help patients and practitioners have the conversation.

But again, we’re very clear about the recommendation because of the potential harm of COVID-19, the clear harm of COVID-19 if you get it in pregnancy, and the safety data we have now around vaccination in pregnancy.

I would also discourage people around the social media that’s going around about the risk of infertility. There’s no data that the COVID-19 vaccine causes infertility. In fact, the studies actually oppose this. There’s no theoretical reason why the COVID-19 vaccines would cause infertility. And so we do recommend that people who are trying to get pregnant get fully vaccinated before they get pregnant, so that they’re protected during their pregnancy.

So we recommend again that persons who are pregnant, persons who are breastfeeding, and anyone planning a pregnancy get the COVID-19 vaccine.

COVID-19 Infection and Vaccination During Pregnancy

Authors: Jennifer Richard, PhD, Department of Psychology, UBC; Liisa Galea, PhD, WHRC Lead | Editors: Negin Nia and Arrthy Thayaparan (Blog Coordinators)

Published: October 8th, 2021

Pregnancy is a vulnerable time for infection due to dynamic changes to the immune system leading to reduced immunity. This also implies an increased risk of people becoming severely sick after contracting COVID-19 (SARS-CoV-2) while pregnant. In fact, COVID-19 infection during pregnancy increases the risk of intensive care (ICU) transmission for the mother, preterm birth, caesarean (c-section) delivery, and admission to neonatal care for the baby. These risks are worsened by the Delta variant, currently the most common variant in Canada, which is up to twice as contagious as previous variants. The rise in Delta variant infections has increased the proportion of pregnant people with severe infection compared to previous variants. More specifically, Delta increases the risk of pregnant people requiring respiratory support, contracting pneumonia, and being admitted to intensive care.

How can we protect pregnant people from COVID-19 infection and related complications?

The best protection, whether you’re pregnant or not, is getting vaccinated. However, the Center for Disease Control and Prevention (CDC) reported that only about 25 per cent of pregnant people in the U.S. have received at least one COVID-19 vaccine dose. Several studies have demonstrated that two doses of AstraZeneca-Oxford and Pfizer-BioNTech COVID-19 vaccines are still effective in preventing severe disease, hospitalization, and death, even against Delta.

Recent studies suggest that two doses of these vaccines provide between 88–95 per cent effectiveness in protecting against the Delta variant. Whether one dose of COVID-19 vaccine is sufficient to protect against Delta is inconclusive. One study reported barely detectable levels of neutralizing antibodies against Delta after one dose of vaccine. On the other hand, a Canadian paper, that has yet to be peer-reviewed, states that one dose of Pfizer-BioNTech, Moderna or AstraZeneca-Oxford provides “good to excellent protection against symptomatic infection and severe outcomes” against Alpha, Beta, Gamma and Delta variants. However, the study also reported reduced protection against Delta compared to the other variants.

Vaccination is also recommended for individuals who have been infected by COVID-19. The vaccination provides superior protection compared to previous infection by another COVID-19 variant. So, despite the Delta variant affecting vaccine effectiveness, vaccinations still remain our best form of protection for severe illness, hospitalizations, and death. This is along with maintaining social distancing, masks, indoor ventilation, and hand hygiene.

COVID-19 vaccine hesitancy and safety in pregnancy

Women tend to be more hesitant towards COVID-19 vaccination than men or gender diverse individuals, with pregnant people reporting an even lower intention of getting vaccinated. The greatest concerns of pregnant people regarding the vaccines are a lack of data on pregnancy safety regarding the vaccines and/or that the vaccine may be harmful for their baby. So what do we know about the safety of COVID-19 vaccines in pregnancy? Can it cause pregnancy loss, affect your chances of conceiving, or alter your genes or the genes of your baby?

Is it safe to get vaccinated against COVID-19 while pregnant?

Pregnant people weren’t included in the initial COVID-19 vaccine trials. However, over 156,000 pregnant people have now been vaccinated with Pfizer-BioNTech or Moderna vaccines in the U.S. with no raised safety concerns. More specifically, the risks for adverse effects relating to pregnancy, including pregnancy loss, birth defects or effects on birth weight, were the same, or lower, than risks reported prior to the pandemic.

Importantly, while the risk of preterm birth was not increased after vaccination against COVID-19, this risk was increased in non-vaccinated pregnant people infected by the COVID-19 virus. As for the more immediate side effects after vaccination, pregnant people reported having a slightly sorer arm (around the injection site). But otherwise, pregnant people actually reported having milder side effects than non-pregnant people, for side effects such as headaches, muscle soreness and fever.

But are COVID-19 vaccines effective in pregnant people?

Although pregnancy causes changes to your immune system, COVID-19 vaccination in pregnant and lactating people provides the same level of immunity against the COVID-19 virus compared to vaccination in non-pregnant people. The level of protection is equal across all three trimesters, as vaccination during the first, second and third trimester gives rise to the same level of antibodies produced against COVID-19. In addition, the level of protection in all vaccinated individuals (non-pregnant, pregnant and lactating) was higher than levels observed in pregnant people who had previously been infected by the COVID-19 virus, indicating that even those who have previously been infected by COVID-19 should get vaccinated.

Can COVID-19 vaccines affect your risk of becoming pregnant?

There is no evidence that vaccination against COVID-19 would affect fertility. In males, COVID-19 vaccination does not result in a reduction in semen volume, sperm concentration or motility. In females, embryo implantation rates were the same as in non-vaccinated individuals. In addition, COVID-19 vaccines can not reach or cross the placenta, they act in the muscle where the vaccine is given. And even if the vaccines could reach the placenta, they can not induce antibodies against, affect or injure the placenta. However, placentas from people who tested positive against the COVID-19 virus during pregnancy showed abnormal blood flow between mother and baby. These data indicate that vaccination during pregnancy is safer than getting infected with COVID-19 during pregnancy.

Since the vaccine rollout, thousands of individuals included in the V-safe Pregnancy Registry have reported becoming pregnant after vaccination. In addition, the rate of accidental pregnancies in vaccinated and unvaccinated individuals were reported at equal levels — showing that vaccines don’t impact pregnancy.

Can the vaccines alter your DNA or the DNA of your baby?

No, vaccines cannot alter your DNA. Pfizer-BioNTech and Moderna are the two most common COVID-19 vaccines given to pregnant people. They are referred to as mRNA vaccines, which carry information (mRNA) to make a part of the COVID-19 virus (spike protein). They can only make a part of the virus, and not the complete virus. The components of the vaccine can’t cause infection in the mother or baby. Neither can they alter your DNA, or the DNA of your baby (mRNA does not alter DNA). The vaccines don’t contain DNA and human cells don’t have the ability to transform RNA to DNA, only the other way around. Therefore, these vaccines are not able to integrate into your DNA, or the DNA of your baby, or cause long-term genetic changes. As an aside – if we could change DNA with mRNA we would already have cures for genetic illnesses such as cystic fibrous or Huntington’s disease.

Can vaccination benefit your baby?

The vaccine provides protection to the baby in the womb indirectly, by lowering the risk of severe sickness in the mother. In addition, COVID-19 vaccination can directly protect your unborn and/or newborn baby, because protective antibodies against COVID-19 cross the placenta, and provide protection against COVID-19 to the baby at birth. In addition, COVID-19-specific antibodies have been found in the umbilical cord of babies, and breast milk, of mothers who were vaccinated during pregnancy.

While cases in babies and small children reported so far have been uncommon, and often cause mild to moderate symptoms, the Delta variant has proven to be more harmful to children. In the U.S., COVID-19 hospitalization rates in children and adolescents increased nearly 5-fold in late summer, a time in which Delta has been the predominant circulating variant. In a recent study from Israel, over 10 per cent of children who were diagnosed with COVID-19 reported symptoms of long COVID, such as continued illness, fatigue or breathlessness. In addition, 30 per cent of parents of affected children reported a decline in “neurological, cognitive, and mental health abilities” compared to prior to COVID-19 infection, for example disturbed sleep and concentration problems. Furthermore, we do not yet know potential long-term effects on children whose mothers were infected while pregnant. Although rare, there are a few cases of newborns born to COVID-19 positive mothers that were tested positive for the virus at birth.This indicates that transmission of COVID-19 from mother to child during pregnancy is possible. Furthermore, the fetus can still be affected by stress, restricted oxygen, reduced placental function and sickness in the mother infected by COVID-19, in addition to the increased risk of preterm birth and c-section delivery.

Taken together, the vaccines provide great protection against symptomatic infection and severe outcomes. Recent data indicates that you are almost 30 times more likely to end up in the ICU if you are unvaccinated. Furthermore, vaccination against COVID-19 during pregnancy is effective, and far safer than the risk of contracting the virus itself, which, while rare, has a 15 times greater risk of death during pregnancy. Vaccination during pregnancy can also benefit the baby by protecting them from indirect effects of disease in the mother, and by providing antibodies against COVID-19. Not to mention it will protect you after giving birth and protect your community. The data overwhelmingly support vaccination during pregnancy as safe and effective.

So, the bottom line is: if pregnant people are concerned about their safety or the safety of their unborn child, getting the shots (of COVID-19 vaccine) is their best shot.

Feature image by Dr. Jennifer Richard